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For 2020, Christus joined three other insurers – Blue Cross and Blue Shield of Louisiana, HMO Louisiana, and Vantage Health Plan – in offering plans through the state’s exchange.

At ACA Signups, Charles Gaba calculated an average rate increase of 11.7 percent for Louisiana’s individual market; the state is one of only three in the country that had double-digit premium increases for 2020.

Louisiana enrollment in qualified health plans

By the end of 2016 open enrollment, the number of Louisiana exchange enrollees reached 214,148 – more than double 2014 enrollment. As of March 2016, nearly 93 percent of Louisiana’s 184,403 effectuated enrollees had premium subsidies.

But Medicaid was expanded in Louisiana in mid-2016, resulting in many lower-income enrollees becoming eligible for Medicaid instead of premium subsidies. The result was much lower enrollment in the exchange for 2017, with 143,577 enrollees by the end of open enrollment.

In 2020, enrollment through the state’s exchange was the lowest it’s ever been – at 88,224. But more than 456,000 people were enrolled in expanded Medicaid as of December 2019.

Short-term health insurance in Louisiana: duration limit depends on how far back the insurer looks for pre-existing conditions

New federal regulations allow short-term plans to have initial terms of up to 364 days, and total duration – including renewals – of 36 months. But the regulations are clear in noting that states may continue to have more restrictive rules.

Has Obamacare helped Louisianans?

Louisiana’s uninsured rate dropped from 16.6 percent in 2013 to 10.3 percent in 2016, but it was still above the 8.6 percent national average at that point. But Medicaid expansion took effect in mid-2016, and by 2018, Louisiana’s uninsured rate had dropped to 8 percent — below the national average of 8.9 percent (the nationwide uninsured rate has trended upward under the Trump administration).

For those who have purchased health insurance in Louisiana, the ACA has helped make coverage more affordable. Of those enrolled in 2019 Louisiana exchange plans, 90 percent were receiving subsidies. And Medicaid expansion has helped hundreds of thousands of low-income Louisiana residents obtain coverage and life-saving treatment: 456,361 people were enrolled in expanded Medicaid as of December 2019, and three-quarters of them had been to the doctor at least once during the year.

Louisiana and the Affordable Care Act

Louisiana’s Senate delegation is currently entirely Republican — Bill Cassidy and John Kennedy, both of whom are opposed to the ACA. Cassidy in particular, played a pivotal role in 2017 in the GOP’s ultimately unsuccessful efforts to repeal the ACA. In the House of Representatives, Louisiana has just one Democrat (Cedric Richmond), who supports the ACA.

Former Gov. Bobby Jindal, whose term ended in January 2016, strongly opposed the Affordable Care Act. He returned a $1 million federal planning grant for exploring a state-run insurance marketplace, defaulted to the federally facilitated marketplace, and rejected Medicaid expansion.

But Jindal was replaced in 2016 by John Bel Edwards, a Democrat who supports the ACA. One of Edwards’ first actions as governor was to expand Medicaid in Louisiana.

Does Louisiana have a high-risk pool?

The Louisiana Health Plan was created in 1992 in order to provide a coverage option for state residents who couldn’t get private plans in the individual market because of their medical histories.

But Obamacare’s guaranteed issue provision means that pre-existing conditions are now covered on all policies, and are no longer factored into the application process. As a result, the need for high-risk pools no longer exists the way it once did. The Louisiana Health Plan terminated all coverage on December 31, 2014, per the terms of House Bill 638 (passed in June, 2013). Members were able to transition to new ACA-compliant plans instead.

Other ACA reform provisions

The ACA’s Consumer Operated and Oriented Plan (CO-OP) Program was established to promote market competition through nonprofit, consumer-run health insurance companies. Twenty-four CO-OPs received loans totaling $2.09 billion as of January 2014, but most failed in the first few years and only four are still operational as of 2020.

Louisiana Health Cooperative received a $65.8 million start-up loan. Louisiana Health Cooperative competed against Blue Cross and Blue Shield of Louisiana, Vantage Health Plan, and Humana during 2014 open enrollment, but struggled with its enrollment goals.

On July 24, 2015, Louisiana’s CO-OP announced it would continue to cover enrollees until the end of the year but would not sell plans in 2016.

Medicare in the state of Louisiana

About 40 percent of all Louisiana Medicare beneficiaries are enrolled in stand-alone Medicare Part D plans. The national percentage is 43 percent. Most Medicare Advantage plans include built-in Part D coverage; stand-alone Part D plans are designed to supplement Original Medicare, which doesn’t include outpatient prescription coverage.